Role of Speech and Language Therapist in Neonatal Intensive Care Unit

When we hear about speech and language therapy we always think the treatment of communication problems and language disorders, but we can for sure say that speech and language therapists who work in neonatal intensive care units (NICUs) have one of the most challenging roles in the entire career field.

With patients far too young to communicate with and unable to express their symptoms and feelings directly, NICU speech and language therapists have to be experts in diagnostic matters and understanding normal childhood development process.

Speech and hearing therapy in the neonatal period is focused on aspects of feeding, the development of hearing and language and mother-infant interactions. The aim of assisting in the feeding process is to promote healthy, efficient feeding in terms of nutrition, weight gain and the mother-infant bond and minimize the risk of aspiration and stress.

But when we turn to speech therapists?

Since newborns can’t speak anyway, some parents are initially confused when a speech and language therapist is included as a part of their child’s care team. But speech and language therapists are the specialists most familiar with swallowing disorders that can dramatically impact a newborn’s ability to take in food during the critical early months of childhood development.

The literature highlights the following criteria for soliciting an evaluation by a speech and language therapist in neonatal units:

• Absence or deficiency of oral reflexes, exacerbated vomiting reflex and severe irritability
• Sialorrhea (excessive salivation)
• Lacking coordination of sucking-swallowing-breathing functions
• Oxygen desaturation
• Abnormal respiratory and heart rates during feeding
• Nasal or gastro-esophageal reflux
• Unexplainable refusal to feed, malnutrition, dehydration and lethargy during feeding.

All premature babies are at risk of experiencing feeding difficulties. It’s not until they reach 40 weeks that all the muscles required for normal feeding are fully developed—and with children with certain childhood diseases, it can take even longer.

The first thing the speech and language therapist will do with a newborn is to make an assessment using a variety of tools and techniques.

They may conduct an Apgar Scoring system to provide a comparative evaluation of the infant’s muscle tone, reflex, irritability and other developmental factors. They will visually assess the physical development of the infant and may conduct a series of neurological tests that evaluate brain development. They may use ultrasound, videofluoroscopy, endoscopic examination and auscultation to determine the physical layout of the baby’s mouth and throat structures.

Studies conducted by speech and language therapists have begun to reveal that even mundane aspects of infant care in the NICU like how the neonates are positioned in the isolettes and the amount of ambient noise in the room can affect their muscle development and ability to perceive and adopt the sounds of speech later in life.

Why we need speech and language therapy?

• Stimulates activities to promote early speech development
• Uses interventions and practices to improve nutrition and safety during this process.
• Improves attention to healthy and early communication
• Stimulates muscles for better oral motor skills
• Uses of massage techniques that can help to regulate the sensitivity and propiocepsion of the mouth and lips area.

Finally, the speech and language therapist plays an important role in the infant’s long-term speech development, by properly educating parents and caregivers. Although the immediate interaction will revolve around demonstrating to parents the proper way to feed the infant at home, the speech and language therapist will also discuss the long-term prognosis for normal speech development.

They may provide the parents with exercises to perform with the baby, or provide them with signs and signals to watch for that could indicate improper physical development and require further intervention.

References:

1. American Speech-Language-Hearing Association. (2004). Roles of Speech-Language Pathologists in the Neonatal Intensive Care Unit: Position Statement. Available from asha.org/policy
2. shttps://www.speechpathologygraduateprograms.org/nicu/
3. Dunn, S., van Kleeck, A., Rossetti, L. (1993). Current roles and continuing needs of speech-language pathologists working in neonatal intensive care units. American Journal of Speech-Language Pathology, 2, 52-64.
4. Fucile, S., Gisel, E., Lau, C. (2002). Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. The Journal of Pediatrics, 141 (2), 230-236.
5. Arvedson, J., Clark, H., Lazarus, C., Schooling, T., Frymark, T. (2010). Evidence-based systematic review: Effects of oral motor interventions on feeding and swallowing in preterm infants. American Journal of SpeechLanguage Pathology, 19, 321-340.
6. Delaney, A., Arvedson, J. (2008). Development of swallowing and feeding: Prenatal through first year of life. Developmental Disabilities Research Reviews, 14, 105-117.
7. Apgar Scoring system. https://hiehelpcenter.org/